Effects of Intensive Voice Treatment (The Lee Silverman Voice Treatment [LSVT LOUD]) in Subjects With Multiple Sclerosis: A Pilot Study.

AIM: The rehabilitation of voice disorders is an unmet need in multiple sclerosis (MS). The Lee Silverman Voice Treatment (LSVT LOUD) is a well-documented and effective speech treatment, developed to treat voice disorders in Parkinson Disease. The purpose of the present study was to examine the viability of applying the LSVT LOUD to individuals with MS and verify short- and long-term improvements in acoustic and perceptual voice parameters. METHODS: A single subject design was performed in a consecutive sample of 8 subjects with MS. The subjects' voice was recorded with PRAAT software for 5 days at baseline during the 16  treatment sessions, and at follow-up (FU) 6/12 months later. PRAAT provided data on sustained /a/ (SPL/a/) voice intensity and maximum phonation time (MPT/a/) of sustained /a/, and on functional sentences voice intensity. In addition, self-assessment questionnaire Voice Handicap Index, the perceptual GIRBAS scale and intensity of monologue were collected at first day of baseline, post-treatment and at FU. In the treatment phase each subject received treatment according to LSVT LOUD protocol. Visual analysis calculated for daily acoustic variables was used to determine baseline stability and analyse changes following treatment. The Wilcoxon test was used to assess statistically significant differences between baseline and post treatment. RESULTS: All participants completed the LSVT LOUD programme; one participant dropped out at FU. Improvements in acoustic analysis were found: SPL/a/ improved on average (± standard deviation) 11.64 ± 4.19 dB with 7 subjects showing statistically significant improvement (P < 0.05); MPT/a/ improved on average 1.2 ± 1.53seconds, while intensity of functional sentences improved on average 8.11 ± 3.46  dB with 4 and 5 subjects showed statistically significant improvement, respectively. Intensity of monologue improved 14.90 ± 3.33 dB. Acoustic values are maintained or increased at FU respect to baseline. All subjects improved perceptual ratings at Voice Handicap Index and results were maintained at FU. These changes were associated with improvements on five parameters on the GIRBAS scale at post-treatment, however no further improvement were observed at FU. CONCLUSION: Intensive LSVT LOUD treatment is a viable approach to treat hypophonia in MS. LSVT LOUD improved both quantitative-instrumental and perceptive-subjective assessments. Randomised controlled trials are needed to provide a firm support on the effectiveness of LSVT LOUD in MS.

Saline-irrigated radiofrequency ablation electrode with external cooling.

INTRODUCTION: Open flush, irrigated ablation electrodes may improve the safety of radiofrequency catheter ablation by preventing protein aggregation and coagulum formation. This is particularly important in left-sided procedures like catheter ablation of atrial fibrillation. Electrode cooling and the inherent loss of temperature feedback, however, grossly reduce the ability to monitor tissue heating. Intimate contact may not be recognized and the delivery of nominal RF power levels may then lead to excessive tissue heating, steam explosions, and even tamponade. METHODS AND RESULTS: Standard, open flush, irrigated catheters (Sprinklr, Medtronic Inc, Minneapolis, MN) were modified by thermally insulating the irrigation channels inside the ablation electrode. Using the thigh muscle preparation, multiple lesions were created with standard and modified catheters using 60 s, 20-50 Watt applications and a constant saline flush rate of 20 cc/min. A total of 57 lesions were created on five thigh muscles of three dogs. Lesion dimensions were not significantly different between both types of catheter, but the maximum electrode temperature rise during ablation was significantly higher with the modified catheter. Insulation of the irrigation channels improved the correlation coefficient between maximum electrode temperature rise and lesion volume from 0.38 (ns) to 0.62 (P < 0.001). CONCLUSION: Thermal insulation of the irrigation channels facilitates temperature feedback during radiofrequency ablation and controllability of lesion formation.